Provider Demographics
NPI:1356461016
Name:VILLAGE OF SOUTH RUSSELL
Entity Type:Organization
Organization Name:VILLAGE OF SOUTH RUSSELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-338-7843
Mailing Address - Street 1:21 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3010
Mailing Address - Country:US
Mailing Address - Phone:440-338-7843
Mailing Address - Fax:440-338-8776
Practice Address - Street 1:21 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3010
Practice Address - Country:US
Practice Address - Phone:440-338-7843
Practice Address - Fax:440-338-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356892Medicaid
OH2356892Medicaid